Targeting Microbubbles

ABSTRACT

This invention related to manufactured microbubbles, as well as methods of using manufactured microbubbles, for example, in medicinal applications. The invention pertains to the physical structure and materials of the microbubbles, as well as to methods for manufacturing microbubbles, methods for targeting microbubbles for specific medicinal applications, and methods for delivering microbubbles in medical treatment.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/154,677, filed on Oct. 8, 2018, which is a divisional of U.S. patentapplication Ser. No. 15/199,710, filed Jun. 30, 2016, (now U.S. Pat. No.10,149,906) which is a divisional of U.S. patent application Ser. No.13/593,747, filed Aug. 24, 2012, which claims the benefit of U.S.Provisional Patent Application Ser. No. 61/527,031, filed Aug. 24, 2011,each of which is hereby incorporated by reference in its entirety.

FIELD OF THE INVENTION

These inventions are directed toward compositions comprising a bubbleforming material, wherein the bubble-forming material comprises ananchoring moiety and a targeting moiety having an affinity formetal-containing, especially calcium-containing, bodies and/orbiological targets. In certain embodiments, these compositions areuseful for providing targeted placement of microbubbles capable ofcavitation on application of high frequency energy.

BACKGROUND OF THE RELATED ART

Cavitation is a component of some currently used medical interventions,such as a treatment for kidney stones. For example, in extracorporealshock wave lithotripsy, shock waves are focused onto a stone in thekidney or ureter. The interaction between the waves and the stoneinduces the formation of cavitation bubbles. The collapse of cavitationbubbles releases energy at the stone, and the energy fragments the stoneinto pieces small enough to be passed via the ureter.

A large number of medical conditions are characterized at least in partby the presence of an abnormal mass. Examples include urinary stones,biliary stones, blood clots, fibroids, cancerous tumors, andatheromatous plaques. Destruction or reduction of the mass withoutinjury to healthy tissue is a goal for many therapeutic treatments.Minimally invasive treatments are preferred as they reduce the pain,discomfort, and risks associated with surgical or other invasivetherapies.

SUMMARY OF THE INVENTION

In one aspect, the disclosure provides a target microbubble comprising:(a) a core containing a fluid having a normal boiling point less thanabout 30° C.; (b) an anchoring moiety comprising a bio-lipid, protein,surfactant, synthetic polymer, or combination thereof; and (c) atargeting moiety comprising a chemical group having an affinity for ametal-containing material, especially calcium-containing, materials, ora small molecule cell specific ligand, including a small molecule tumorcell specific ligand.

In other aspects, certain embodiments provide solutions comprising aplurality of the targeting microbubbles dispersed in a solvent, wherethe solvent may be water or a physiological fluid.

In another aspect, the disclosure provides methods for preparing asolution, each method comprising combining a bubble-forming material anda solvent, wherein the bubble-forming material comprises an anchoringmoiety and a targeting moiety comprising a chemical group having anaffinity for a metal-containing material, especially acalcium-containing, material, or a small molecule cell specific ligand,including a small molecule tumor cell specific ligand.

In yet another aspect, the disclosure provides methods for preparing asolution of microbubbles, each method comprising delivering energy to asolution comprising a bubble-forming material and a solvent, wherein:(a) the bubble-forming material comprises an anchoring moiety and atargeting moiety, said targeting moiety comprising a chemical grouphaving an affinity for metal-containing materials, especiallycalcium-containing, materials or a small molecule cell specific ligand,especially a small molecule tumor cell specific ligand; and (b) theenergy is sufficient to cause the bubble-forming material to formmicrobubbles in the solvent

In another aspect, the disclosure provides methods for treating apatient, each method comprising applying energy to microbubbles disposedwithin the patient, wherein the microbubbles comprise a targeting moietywith a specific affinity to a target within the patient, and wherein theenergy is effective to cause cavitation of the microbubbles. In anotheraspect, the disclosure provides a method for treating a patient, themethod comprising: (a) delivering a solution comprising microbubbles toa site within the patient; and (b) applying energy to the microbubbles,wherein the energy is in the form of electromagnetic, ultrasound,microwave, or other energies and is sufficient to cause cavitation ofthe microbubbles, and wherein the cavitation releases sufficient energyto cause destruction of a cell, tissue, or calculous mass at the sitewithin the patient.

These and other aspects will be apparent from the disclosure providedherein, including the claims, figures, and examples.

BRIEF DESCRIPTION OF THE DRAWINGS

The present application is further understood when read in conjunctionwith the appended drawings. For the purpose of illustrating the subjectmatter, there are shown in the drawings exemplary embodiments of thesubject matter; however, the presently disclosed subject matter is notlimited to the specific methods, devices, and systems disclosed. Inaddition, the drawings are not necessarily drawn to scale. In thedrawings:

FIG. 1 provides a photographic image of a kidney stone after an in vivotreatment using a method according to the disclosure.

FIG. 2 illustrates one embodiment of the present invention in which adipolar compound (bisphosphonic acid linked to a quaternary ammoniumcompound) serves to conjoin a target material with a negatively chargedanchoring moiety (e.g., phospholipid) attachable to a microbubble.

FIG. 3A provides a pictorial representation of treatment of a kidneystone with HCl. FIG. 3B provides a pictorial representation of treatmentof a kidney stone with linked quaternary salt as described in Example 5.

FIGS. 4A, 4B, and 4C show attachment and cavitation of microbubble tokidney stone, and damage caused thereby. See Example 5. FIG. 4Aillustrates the successful attachment of the microbubble to the kidneystone (calculous). Without the pretreatment described in Example 5, themicrobubbles did not attach. FIG. 4B shows an in situ picture of themicrobubble bursting. FIG. 4C shows the multiple pitting damage causedby the cavitation. The surface of this stone was smooth beforemicrobubble treatment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention may be understood more readily by reference to thefollowing description taken in connection with the accompanying Figuresand Examples, all of which form a part of this disclosure. It is to beunderstood that this invention is not limited to the specific products,methods, conditions or parameters described and/or shown herein, andthat the terminology used herein is for the purpose of describingparticular embodiments by way of example only and is not intended to belimiting of any claimed invention. Similarly, unless specificallyotherwise stated, any description as to a possible mechanism or mode ofaction or reason for improvement is meant to be illustrative only, andthe invention herein is not to be constrained by the correctness orincorrectness of any such suggested mechanism or mode of action orreason for improvement. Additionally, throughout this text, it isrecognized that the descriptions refer both to the compositionscomprising and methods of making and using targeting microbubbles. Thesecertain compositions or methods may be described in terms of certainembodiments or features. Where the disclosure describes and/or claims aparticular feature in a composition or method, it is appreciated thatsuch a feature is intended to relate to all compositions or methodsdescribed herein.

In the present disclosure the singular forms “a,” “an,” and “the”include the plural reference, and reference to a particular numericalvalue includes at least that particular value, unless the contextclearly indicates otherwise. Thus, for example, a reference to “amaterial” is a reference to at least one of such materials andequivalents thereof known to those skilled in the art, and so forth.

When a value is expressed as an approximation by use of the descriptor“about,” it will be understood that the particular value forms anotherembodiment. In general, use of the term “about” indicates approximationsthat can vary depending on the desired properties sought to be obtainedby the disclosed subject matter and is to be interpreted in the specificcontext in which it is used, based on its function. The person skilledin the art will be able to interpret this as a matter of routine. Insome cases, the number of significant figures used for a particularvalue may be one non-limiting method of determining the extent of theword “about.” In other cases, the gradations used in a series of valuesmay be used to determine the intended range available to the term“about” for each value. Where present, all ranges are inclusive andcombinable. That is, references to values stated in ranges include everyvalue within that range.

It is to be appreciated that certain features of the invention whichare, for clarity, described herein in the context of separateembodiments, may also be provided in combination in a single embodiment.That is, unless obviously incompatible or specifically excluded, eachindividual embodiment is deemed to be combinable with any otherembodiment(s) and such a combination is considered to be anotherembodiment. Conversely, various features of the invention that are, forbrevity, described in the context of a single embodiment, may also beprovided separately or in any sub-combination. It is further noted thatthe claims may be drafted to exclude any optional element. As such, thisstatement is intended to serve as antecedent basis for use of suchexclusive terminology as “solely,” “only” and the like in connectionwith the recitation of claim elements, or use of a “negative”limitation. Finally, while an embodiment may be described as part of aseries of steps or part of a more general structure, each said step mayalso be considered an independent embodiment in itself.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although any methods andmaterials similar or equivalent to those described herein can also beused in the practice or testing of the present invention, representativeillustrative methods and materials are described herein.

As used herein the term “microbubble” refers to any container, coil, orother space conforming geometry. Unless otherwise specified, the terms“microbubbles” and “bubbles” are used interchangeably.

Definitions of other terms and concepts appear throughout the detaileddescription below.

In some aspects of the disclosure, there is herein provided methods andmaterials for synthesizing microbubbles for medical applications.Chemical tags are attached to biocompatible microbubbles and themicrobubbles are then delivered to a patient. The chemical tags have anaffinity for a targeted mass, tissue, or structure, such thatmicrobubbles concentrate near the target. Ultrasound or another suitableform of energy is then applied causing the microbubbles to inducecavitation. Cavitation of microbubbles causes the delivery of energy ator near the target. For example, where the target is an unwanted mass,cavitation causes the mass to break apart into smaller pieces that maybe removed from the patient or may pass from the patient via normalbiological processes. In another example, where the target is abiological entity such as a tissue or cell, cavitation causesdestruction of the entity and/or disruption of biological processesinvolving the entity.

Various embodiments of the present invention provide methods forpreparing a solution, each method comprising combining a bubble-formingmaterial and a solvent, wherein the bubble-forming material comprises ananchoring moiety and a targeting moiety a targeting moiety comprising:(i) a chemical group having an affinity for a metal-containing material;or (ii) a cell specific ligand.

Still other embodiments provide targeting microbubbles, each microbubblecomprising: (a) a core containing a fluid having a normal boiling pointless than about 30° C.; (b) an anchoring moiety comprising a bio-lipid,protein, surfactant, or synthetic polymer; and (c) a targeting moietycomprising: (i) a chemical group having an affinity for ametal-containing material; or (ii) a cell specific ligand. In certain ofthese embodiments, the targeting moiety may either have an affinity fora metal-containing material; e.g., a calcium-containing material, suchas a atheromatous plaque, biliary stone, a calcified tissue or plaque, acancerous tumor, or a urinary stone; or, by virtue of a small moleculecell specific ligand, have an affinity for blood clots, fibroids,cancerous tumors, and/or atheromatous or other plaques.

Other embodiments provide solutions, each comprising a plurality oftargeting microbubbles dispersed in a solvent, wherein the solvent mayinclude water or some other physiological fluid. As used herein, theterm “physiological fluid” refers to a fluid of the body, for example,including blood, lymph fluid, saliva, bile, urine, and interstitialfluid.

In these, and other embodiments throughout this disclosure, suchcalcium-containing materials may be found within or outside the body ofa patient, for example, including atheromatous or othercalcium-containing plaque (e.g., dental plaque), biliary stone, acalcified tissue or plaque, a cancerous tumor, or a urinary stone. Also,as used herein, the term “targeting moiety having an affinity to metal-or calcium-containing materials” refers to a chemical moiety, which byvirtue of its chemical affinity for metal- or calcium salts (e.g.,calcium carbonate, calcium oxalate, calcium phosphate, orhydroxyapatite) has a tendency to complex with such salts.Bisphosphonate is one such moiety particularly useful forcalcium-containing materials, and is a preferred embodiment of thepresent invention.

As used herein, the term “small molecule cell specific ligand” isintended to connote a ligand comprising a cell specific ligand having amolecular weight less than about 1000 Daltons and having an affinity fora particular type of cell or cells, and be distinguished from antibodyor protein-based ligand. In certain embodiments, the cell specificligand is a cancer tumor cell specific ligand, such as a folate (see,e.g., Example 6, below), which is known to be a very selective receptorto cancerous tumors and it is not harmful to healthy cells.

In each of the embodiments contemplated herein, the anchoring moiety andthe targeting moiety of the various embodiments may be linked by one ormore covalent, ionic, or hydrogen-bonding linkages. In such embodiments,the bubble-forming material may further comprise a polymeric linkingmoiety that covalently links the anchoring moiety with the targetingmoiety, as discussed below. In other embodiments, the anchoring moietyis directly chemically attached to the targeting moiety. Further, theanchoring moiety may comprise a bio-lipid, synthetic polymer,surfactant, and/or a protein.

Where the targeting microbubbles comprise a core containing a fluidhaving a normal boiling point less than about 30° C. or 35° C., such maycomprise air, CO₂, a fluorinated or perfluorinated C₁₋₆ hydrocarbon(e.g., perfluoropropane), or a combination thereof. In some embodiments,the core may comprise a fluid comprising a condensed gas; i.e., thecomposition is at a temperature below the boiling point of the fluid.For example, pentafluoropentane, with a boiling point of 29.5° C., mayexist as a liquid at ambient temperature, but as a gas at physiologicaltemperatures (e.g., 37° C.). Such a fluid is considered within the scopeof the present invention.

This invention also teaches methods for preparing a solution ofmicrobubbles, each method comprising delivering energy to a solutioncomprising a bubble-forming material and a solvent, wherein thebubble-forming material comprises an anchoring moiety and a targetingmoiety, such that the energy is sufficient to cause the bubble-formingmaterial to form microbubbles in the solvent. Again, in theseembodiments, the targeting moiety also either have an affinity for acalcium-containing material (or other metal target) or, by virtue of asmall molecule cell specific ligand, have an affinity for blood clots,fibroids, cancerous tumors, and/or atheromatous or other plaques. Invarious embodiments, the bubble-forming material further comprises abio-lipid, surfactant, synthetic polymer, or protein, wherein thecompound is not chemically linked to the targeting moiety.

Additional embodiments provide methods of treating a patient, eachmethod comprising applying energy to microbubbles disposed within thepatient, wherein the microbubbles comprise a targeting moiety with aspecific affinity to a target within the patient, and wherein the energyis effective to cause cavitation of the microbubbles. In certainembodiments, the methods further comprise administering the microbubblesto the patient prior to applying the energy, for example via injection,inhalation, or implantation. In some of these embodiments, the target isa calcium-containing mass, a cancerous cell, a tumor, or a tissue. Insome embodiments where the target is a calcium-containing mass, thecavitation causes damage to the target. In other embodiments where thetarget is a cancerous cell, the cavitation causes lysis of the target.In still other embodiments where the target is a renal or urinary stone,biliary stone, blood clot, fibroid, cancerous tumor, or atheromatous orother plaque, the cavitation causes damage to the target. In certain ofthese embodiments, the microbubbles further comprise a bio-lipid,synthetic polymer, protein, or surfactant, but the compound is lacking atargeting moiety. The microbubbles may be alternatively attached to thetarget, or not attached, in the latter case being proximate to thetarget.

Still other embodiments include methods of treating a patient, eachmethod comprising: (a) delivering a solution comprising microbubbles toa site within the patient; and (b) applying energy to the microbubbles,wherein the energy is in the form of electromagnetic or ultrasoundenergy and is sufficient to cause cavitation of the microbubbles, andwherein the cavitation releases sufficient energy to cause destruction(e.g., lysis or fracture) of the target cell, tissue, tumor, orcalcium-containing or other mass at the site within the patient—e.g., tothe target renal or urinary stones, biliary stones, blood clots,fibroids, cancerous tumors, and atheromatous plaques. In certain relatedembodiments, the microbubbles do not contain a targeting moiety. Inthese embodiments, the solution may be delivered by any method describedherein for such purpose, but especially via implantation, inhalation,injection, or by catheter. Where by inhalation or injection, it isenvisioned that the microbubbles have an affinity for a cell, tissue, orcalcium-containing mass at that site within the patient.

Various microbubble products are available commercially, includingmicrobubbles marketed under the trade names ALBUNEX®, DEFINITY®, andOPTISON®. In some embodiments, the microbubbles used in the proceduresdescribed herein are selected from such commercially available materialsand are further modified to include targeting moieties as describedherein.

An example for illustrative purposes is provided as follows. In oneembodiment, microbubbles are prepared having chemical tags that aresuitable for binding to kidney stones. Such chemical tags may be, forexample, bisphosphonate pendants. The microbubbles are administered to apatient suffering from kidney stones. Ultrasound is applied to cause themicrobubbles to cavitate and break apart the kidney stones into smallerparticles. The smaller particles pass through the kidney/ureternaturally and with limited or no discomfort to the patient.

Prior medical applications of cavitation have used extracorporeal energysources to create and collapse air bubbles in the tissue. The methodsdisclosed herein differ from such procedures by utilizingapplication-specific, gas-containing bubbles that are manufacturedex-vivo. The manufactured bubbles are specifically delivered to thesurface or vicinity of the targeted tissue or mass. Alternatively, thebubbles contain targeting tags that allow them to concentrate on or nearthe targeted tissue or mass. Energy from external sources (e.g.ultrasound, RF energy, or the like) is then applied in order to inducecavitation. The engineered bubbles act as a cavitation nucleus uponinteraction with ultrasound or by absorption of radio frequency energycausing local heating and cavitation. Expansion of bubbles and theirrapid collapse causes a shock wave that can fragment or lyse thetargeted mass. For certain masses, the release of energy will causefragmentation, as in the case of kidney stones. For other conditions,the energy release will cause the lysis of cells, as in tumors.

Microbubble Characteristics

The microbubbles of interest include a shell surrounding a hollow core.In some embodiments, the shell is composed of bio-lipids, proteins(e.g., albumin), surfactants, biocompatible polymers, or any combinationthereof. Specific examples of such materials are provided herein below.In some embodiments, the hollow core is filled with a gas or low boilingfluid, and examples of such gases and fluids are also provided hereinbelow. The microbubbles are designed with a shape and size to nucleatecavitation, which refers to the formation and collapse of gaseousbubbles. The violent collapse of cavitation bubbles releases energy thatcan cause the fragmentation of an adjacent mass.

In some embodiments, the microbubbles described herein are modified tocarry chemical tags (referred to herein as “targeting moieties” or“functional moieties”) on or near their surface. Such tags are selectedto target specific locations, masses, or structures in vivo. Because ofthe targeting, microbubbles concentrate at the targeted location, mass,or structure and can be used in therapeutic treatments as describedherein.

Alternatively or in addition, the microbubbles can be used to transporta load of material within the core to a specific mass, location, orstructure in vivo.

For example, gas-filled microbubbles are synthesized with one or moretags for targeting a specific tissue, tumor, mass, stone or bone. Thebubbles are delivered to the target as part of a pharmaceuticallyacceptable formulation. Upon attachment to or association with thetarget, cavitation is induced with consequent disruption orfragmentation of the target.

The contents of the bubble can vary with application. In someembodiments, the bubble contains air, CO₂, a fluorinated orperfluorinated gas (e.g. a perfluorinated alkane such asperfluoropropane), another gas, or mixtures thereof. In otherembodiments, the bubble may contain a low boiling (e.g., normal boilingpoint less than about 30° or 35° C.). This allows that a deflated bubblemay be injected into the patient, said bubble inflating as it heats tophysiological temperatures (ca. 37° C.). In other embodiments, thebubbles can be filled partially or completely with a payload other thana gas, such as a pharmaceutically active agent, a cytotoxic agent, animaging agent, or the like.

The bubbles are intended for delivery to the site of a targeted mass ortissue that is to be reduced in size or eliminated. The bubbles aretagged with a targeting moiety so that they selectively bind orassociate with the target.

Various sizes and shapes of bubbles are suitable based on the specificintended applications. In some embodiments, the microbubbles areselected from spherical, ellipsoidal, disk-shaped, and asymmetricshapes. In some embodiments, the shape of the bubbles is not static. Forexample, in some embodiments, the unperturbed bubbles may be spherical,but the bubbles may adopt a different shape such as ellipsoidal ordisk-shaped when an external force (e.g., a flowing fluid such as blood)is present.

In some embodiments, the microbubbles have an average diameter (wherein“average diameter” refers to the largest dimension for non-spheroidalshapes) between 0.1 μm and 10 μm, or between 0.5 μm and 10 μm, orbetween 1 μm and 10 μm. In some embodiments, the average diameter isbetween 0.5 μm and 3 μm, or between 1 μm and 2 μm. In some embodiments,the microbubbles have an average diameter less than 10 μm, or less than5 μm, or less than 1 μm, or less than 0.5 μm, or less than 0.1 μm. Insome embodiments, the microbubbles have an average diameter greater than0.1 μm, or greater than 0.5 μm, or greater than 1 μm, or greater than 5μm, or greater than 10 μm. The synthetic processes described hereinallow the production of bubbles of various sizes and materials. It willbe appreciated that use of the term “microbubbles” is not intended tolimit the size of the bubbles to any particular range (e.g., microndiameters).

In some embodiments, the microbubbles are targeted to the mass ofinterest by the attachment of a targeting agent or tag, for example tothe surface of the bubble. For example, microbubbles can be chemicallyfunctionalized using a variety of techniques, the details of suchtechniques being dependent on the exact chemical moiety to be attached.

Examples of methods of attachment of the targeting moieties includecovalent and ionic bonds. The targeting moiety is chosen based onproperties of the target tissue or mass as well as the structure andchemical properties of the microbubbles. A variety of targeting moietiesmay be used, some of which are described in more detail below.

Targeting moieties and other functional groups can be attachedasymmetrically or in patterns as needed for a particular application. Insome embodiments there is directional modification of the surface of thebubbles. For some applications, only one part of the surface of themicrobubble is functionalized with a tagging moiety in order to directenergy toward or away from the intended target.

Delivery and Administration

Delivery into or near the targeted mass, tissue, tumor, stone, bone orother site of interest can be achieved by a variety of means, asappropriate for the application. Bubbles may be introduced, as examples,by injection or spray. Depending on specific formulations, preparationsmay be prepared using surfactants or other additives for dispersal. Insome embodiments, bubbles are introduced to the blood, bile, urine, orcerebral spinal fluid. In some embodiments, bubbles are introduced toorgans by percutaneous injection. In some embodiments, bubbles areintroduced via an orifice of the body. Orifices include any opening suchas the mouth, nose, eyes, vagina, urethra, and ears. In someembodiments, bubbles are introduced under the skin.

In some embodiments, bubbles are introduced directly at the target site,such as by direct implantation into a target tissue or mass. In somesuch cases, it is not necessary for the bubbles to be manufactured withtargeting agents.

In other embodiments, bubbles are introduced at a remote location (e.g.,into the bloodstream via percutaneous injection) and are allowed toconcentrate at the targeted site.

In each of these methods it will be appreciated that the bubbles areintroduced as part of a pharmaceutical formulation which may include,for example, solvents or other carriers, additives (e.g., stabilizersand preservatives, colorants, surfactants, pH-modifiers, etc.), and/orone or more pharmaceutically active agents.

Treatment

After introduction of the bubbles and attachment or association of thebubbles with the target, cavitation may be initiated by a variety ofmeans. In some embodiments such means involve application of energy,where such energy is generated ex vivo. Examples include application ofdirected ultrasound and radio waves. In some embodiments,electromagnetic (EM) energy of frequencies between 400 kHz and 10 MHz issuitable because it propagates through tissue without stronginteractions (due to low electrical conductivity). In one example,standard ultrasound units are applied within or adjacent to the bodywith sufficient power to initiate cavitation of the pre-positionedbubbles.

Materials and Methods

In some embodiments, preparations of the microbubbles used herein arecarried out according to literature procedures, with appropriatemodifications as necessary. The functionalized (i.e., tagged)microbubbles may be prepared by functionalizing a bubble-formingmaterial. Alternatively, microbubbles can be prepared fromun-functionalized materials and then subsequently functionalized afterbubble formation.

In some embodiments, microbubbles suitable for medicinal applicationsare prepared by adapting a process for creating hollow spheres for usein paints and surface treatments (C. J. McDonald and M. J. Devon,Advanced in Colloid and Interface Science, 2002, 99, 181-213).

In some embodiments, microbubbles (including multi-layered microbubbles)are prepared using methods known in the art; for example, according tothe process reported in Liu et al., J. Controlled Release, 114 (2006)89-99, and references cited therein. In some embodiments, microbubblesare prepared according to the process reported in Hu et al., J.Controlled Release, 147 (2010) 154-162, and references cited therein. Insome embodiments, microbubbles are prepared according to the processreported in Hernot et al., Adv. Drug Delivery Rev. 60 (2008) 1153-1166,and references cited therein. In some embodiments, microbubbles areprepared according to the process reported in Geers et al., J.Controlled Release 148 (2010) e57-e73 (abstracts), and references citedtherein. In some embodiments, microbubbles are prepared according to theprocess reported in Tinkov et al., J. Controlled Release 143 (2010)143-150, and reference cited therein. Additional synthetic details forpreparing (untagged) microbubbles can be found in Mayer et al., Adv.Drug Delivery Rev. 60 (2008) 1177-1192. The procedures from any of theabove-cited references can be modified according to the examplesprovided herein below so as to prepare the targeting microbubbles ofinterest.

Various materials can be used in the manufacture of bubbles. In someembodiments, the bubble-forming material includes an anchoring moietyand a targeting moiety. In some embodiments, the anchoring moiety ishydrophobic and the targeting moiety is hydrophilic. Alternatively, theanchoring moiety is hydrophilic and the targeting moiety is hydrophobic.It will be appreciated that in either of these cases, the bubble-formingmaterial is amphiphilic. The bubble-forming material may further containone or more additional moieties as described below

In some embodiments, the various components of the bubble-formingmaterial are chemically bonded to each other via covalent bonds, ionicbonds, hydrogen bonds, or a combination thereof. In some embodiments,two or more of the various components are separate molecules (notchemically bonded) but are associated with each other as part of thesame microbubble. For example, the “anchoring moiety” may be a separatecompound from the “targeting moiety,” and both compounds together formmicrobubbles.

In some embodiments, the targeting moiety comprises a chemical grouphaving an affinity for a metal-containing material. As used herein, ametal-containing material comprises any of the elements of Group 2 toGroup 12, and the metals of Groups 13-15, though materials comprisingcalcium are especially attractive targets for the present invention. Thevariety of structured, chemical, and other characteristics capable ofproviding an affinity to a metal-containing material are too numerous tomention here, but are known to those skilled in the art. For example,such groups will generally include functional groups capable ofinteracting with such surfaces; e.g., heteroatoms such as nitrogen,oxygen, sulfur and phosphorus. One such a chemical group may be a bi- orpoly-dentate chelant having at least two amino, carboxy, hydroxyl,phosphoryl, or thiol groups, or a combination thereof. Examples includeamino acids or polyamino acids, triols, polyamines, polycarboxylates, orcombinations thereof.

In some embodiments, the targeting moiety is a phosphonate such as abisphosphonate. Bisphosphonates are useful agents for targeting renal orurinary stones, and are part of a family of bone-targeting agents (anyof which may be used herein as desired). For example, neridronate andalendronate have the appropriate functionality to attach to kidneystones and other calculous masses. Other targeting moieties includeantibodies and specific antigens (e.g. biotin/streptavidin).

In some embodiments, the targeting moiety is a cytokine or chemokinesuitable for targeting the microbubbles to cells expressing acorresponding receptor. Examples of suitable ligands are provided in Huet al., J. Controlled Release, 147 (2010) 154-162. Such ligands may beincorporated into the microbubbles via attachment to a bubble-formingmaterial, or may be used as a bubble-forming material and therebyincorporated directly into the microbubbles. Examples of suitablereceptors that can be targeted in this manner are also reported in Hu etal.

In some embodiments, the targeting moiety does not provide targeting perse, but provides one or more functional properties. For example,functionalizing markers include metal complexes, spin labels, andfluorescent tags or radioactive labels to enhance identification withroutine radiographic, ultrasound or magnetic resonance imaging. Suchfunctional moieties are particularly suitable where the microbubbles areintended for direct implantation at or near the target. In someembodiments, a combination of functional moieties and targeting moietiesare used.

In some embodiments, the anchoring moiety is selected from bio-lipids(e.g. phospholipids), surfactants, proteins (e.g., denatured human serumalbumin), or biocompatible synthetic polymers, or combinations thereof.

For example, the anchoring moiety may be a synthetic polymer. Someexamples of suitable polymers include PEG, polylactide, polyglycolidepolyacrylates, polymethacrylates, and vinyl polymers such aspolystyrene, as well as co-polymers thereof (e.g.,poly(lactide-co-glycolide)). The structure and molecular weight of thepolymer can be adjusted based on the desired application. In someembodiments, the molecular weight of the polymer is less than about10,000 Da, or less than about 5000 Da, or less than about 1000 Da. Insome embodiments, the molecular weight of the polymer is greater thanabout 1000 Da, or greater than about 5000 Da, or greater than about10,000 Da. The polymer may be linear or non-linear, such as branched orcomb-like.

In some embodiments, the anchoring moiety is a surfactant orphospholipid that further comprises an attached polymeric moiety. Insome such embodiments, the polymeric moiety functions as a linker thatlinks the targeting moiety to the anchoring moiety. For example, PEGmoieties of various lengths (e.g., 1-30 repeat units as described above)can serve to provide a flexible linker moiety.

Some examples of additional moieties that may be included in thebubble-forming material include lipids and steroids. For example, acholesterol moiety may be included as described below.

In some embodiments, the targeting moiety is chemically attached to theanchoring moiety. Such chemical attachment includes attachment via acovalent, ionic, or hydrogen bond. In some embodiments, as describedpreviously, a linking moiety is present, and the targeting moiety andanchoring moiety are indirectly chemically attached via the linkingmoiety.

Chemical attachment (also referred to as conjugation) of the targetingmoiety to the anchoring moiety (either directly or via a linking moiety)may be carried out using any of the methods described herein, as well asstandard synthetic methods such as via the use of thioether, amide, ordisulfide bonding. The conjugation reaction may be carried out prior toor after bubble formation.

In some embodiments, each molecule of bubble-forming material contains asingle targeting moiety, whereas in other embodiments each moleculecontains a plurality of targeting moieties. For example, abubble-forming material prepared from a branched polymer may containnumerous targeting moieties (e.g., one targeting moiety at the end ofeach branch in the polymer).

In some embodiments, the microbubbles are prepared from a singlebubble-forming material such as those described above. In suchembodiments, each microbubble contains at least as many targetingmoieties as individual molecules, because each bubble-forming moleculecontains at least one targeting moiety.

In some embodiments, the microbubbles are prepared from a mixture ofmaterials. In some such embodiments, one or more of the bubble-formingmaterials may be functionalized with a targeting moiety, while one ormore of the bubble-forming materials does not contain a targetingmoiety. By mixing functionalized with un-functionalized bubble-formingmaterials in this manner, the density of targeting moieties on eachmicrobubble can be adjusted as desired.

In some embodiments, the targeting moieties are disposed exclusively onthe exterior surface of the microbubbles. In other embodiments, some orall of the targeting moieties are disposed beneath the exterior surfaceof the microbubbles. It will be appreciated that the location of thetargeting moieties may be dependent upon environmental conditions suchas solvent polarity, pH, ionic strength, etc., and may change withchanging conditions.

An alternative method for manufacturing medical bubbles incorporatestechniques used in fabrication of titanium micro-electromechanicalsystems (MEMS). MEMS technology is used to form shaped spheres. Thefabrication process uses well established micro-processing techniques.

Suitable methods for storage of the bubbles are determined according toproperties and applications of specific bubbles and may require water,surfactant, oil or other medium.

In one particular example, the bubble-forming material is abisphosphonate having the structure shown below:

In this example, the PEG chain lengths may be varied from 1 to 30 orgreater. This material may be synthesized analogously to the procedureoutline in Bhushan et al., Angewandte Chemie International Edition 2007,46, 7969-7971. A similar example is a cholesterol derivative containinga phosphonate moiety with the following structure:

In another specific example, the microbubbles are formed from a lipidshell. Between about 1% and about 25% of the lipid molecules arecovalently attached to polymer molecules, with the percentage beingselected based on a variety of factors such as polymer molecular weightand the identity of the microbubble components. The polymer moleculesform a stabilizing layer around the shell. Some or all of thestabilizing polymer molecules contain an attached targeting moiety thatis suitable for the desired application. For example, the materialdescribed in Deelman et al., Adv. Drug Delivery Rev. 62 (2010) 1369-1377can be modified according to the procedures disclosed herein in order tocontain appropriate targeting moieties.

As illustrated in the Examples included below, solutions of microbubblesmay be prepared by combining the bubble-forming material with a solventand then applying energy to induce bubble formation. In someembodiments, such energy is applied in the form of mechanical(vibrational) energy by shaking or otherwise mixing the solution. Insome embodiments, such energy is applied in the form of ultrasoundenergy sufficient to induce bubble formation (but not sufficient toinduce cavitation). As used herein, the term “pre-bubble solution”refers to a solution comprising a bubble-forming material and a solventprior to the application of energy sufficient to induce bubbleformation. It will be appreciated, however, that a solution ofmicrobubbles may, over time, revert back to the state of the pre-bubblesolution (i.e., where bubble-forming material is present but no bubblesare present). It will further be appreciated that the microbubbles canbe re-formed by applying additional bubble-forming energy. Formulation

The manufactured bubbles can be prepared for introduction to a humanpatient, for example by injection, spray, implantation, or the like. Asrequired for medical applications, bubbles are prepared as effectiveamounts in a pharmaceutical preparation in a pharmaceutically acceptablecarrier.

In some embodiments, the microbubble product is prepared forintroduction to a patient or subject. The product may be dispersed influid for injection or formulated as an aerosol spray for introductionnear the target.

In some embodiments, the microbubbles are prepared as a slurry oremulsion suitable for injection, administration via an aerosol spray, orintroduction via a catheter.

In addition to the microbubbles and a pharmaceutically acceptablecarrier, various other agents may be added to the formulations asdesired. In some embodiments, one or more surfactants are included inthe formulation. In other embodiments, no surfactants are added to themicrobubble formulation. Other additives that may be present includepH-modifying agents, preservatives, labeling compounds and/or imageenhancing compounds, salts, and the like. Applications

The methods and materials described herein are appropriate for manyapplications. For example, medicinal bubbles as disclosed herein aresuitable to be used in both human and animal medicine as well as inexperimental models.

In some embodiments, the methods and materials of interest provideminimally invasive treatment of medical conditions, including treatmentsthat do not require expensive and bulky equipment for administration toa patient.

A large number of medical conditions are characterized at least in partby the presence of an abnormal mass. Examples include urinary stones,biliary stones, blood clots, fibroids, cancerous tumors, andatheromatous plaques. The methods and materials described herein providedestruction or reduction of the mass with minimal injury to healthytissue and thus provide therapeutic benefit. The therapeutic methods areminimally invasive and are characterized by reduced pain, discomfort,and risks that are associated with open surgical or other invasivetherapies.

In a specific example, the methods and materials disclosed herein aresuitable for the treatment of kidney stones. In one example of suchtreatment, targeting microbubbles are injected into the ureter, and uponbinding to the kidney stone, ultrasound is applied either locally or viaan extracorporeal source to cause cavitation of the microbubbles. Thiscavitation breaks apart the kidney stone into small particles that canbe released by the body, for example following the administration of adiuretic.

The following are additional examples of uses of the materials andmethods disclosed herein. Such examples are not intended as a limitationon the invention.

A microbubble solution may be prepared for injection into excess adiposetissue to remodel or destroy intended targets.

A microbubble solution may be prepared for injection into the lenscapsule for subsequent removal in cataract surgery.

A microbubble solution may be prepared for injection into joints todestroy offending cartilage or to facilitate remodeling of bone.

A microbubble solution may be prepared for injection into blood streamto target and lyse occlusive blood clots.

A microbubble solution may be prepared for injection into blood streamsto target and fracture atheromatous plaques.

A microbubble solution may be prepared for injection into targetedtissue to facilitate fenestration.

A microbubble solution may be prepared for injection into posteriorpharynx to induce scarring to alleviate sleep apnea.

A microbubble solution may be prepared for injection into mammary tissueto facilitate breast reductions.

A microbubble solution may be prepared for injection into reproductivetract to facilitate sterilization.

A microbubble solution may be prepared for ex-vivo applications totarget selected sperm (male vs. female).

EXAMPLES Example 1: Synthesis of Targeting Microbubbles

A solution of microbubbles is synthesized according to the followingprocedure.

First, a modified bisphosphonate lipid is synthesized. The amine groupof compound 1, which is commercially available, is protected as shown togive compound 2. The phosphonate hydroxyl of 2 will subsequently bemethylated to yield 3, which is reacted with trifluoroacetic acid inmethylene chloride to generate product 4.

Concurrently, compound 5, which is commercially available, is reacted toform 6, which is directly carried on to form compound 7. This procedureis done following a method discussed in Bhushan et al., AngewandteChemie Chemie Int. Ed. 2007, 46, 7969-7971.

Products 4 and 7 are then coupled together in the presence of base andheat to yield compound 8. Deprotection of the methoxy functionalities tohydroxyl functionalities affords target product 9.

The microbubble solution is then prepared as follows. The concentrationsand solutions are prepared to mimic “Definity” microbubbles (see Example2 for general procedure). For a 50 mL solution of the properconcentrations, a buffer solution is made as follows. Propylene glycol(5.1750 g), glycerin (6.3100 g), NaPhosphate monobasic.times.1H2O(0.1170 g), NaPhosphate dibasic 10-hydrate (0.1080 g), and NaCl (0.2435g) are combined with 25 mL of distilled water, measured with avolumetric flask. The lipid solution is prepared in chloroform. Ten mLstock solutions of each of the lipids are made in chloroform, and a 25mL solution is made from these stock solutions. For DPPA, 4.5 mg iscombined with 10 mL of chloroform in a 10 mL volumetric flask. For lipid9, 26.67 mg is added with 10 mL of chloroform in a 10 mL volumetricflask, and likewise for MPEG5000 DPPE, 30.4 mg is combined with 10 mL ofchloroform in a 10 mL volumetric flask. Subsequently 5 mL of each of thestock solutions is combined, and this combined solution is diluted to a25 mL volume of chloroform in a 25 mL volumetric flask. This 25 mL lipidsolution will then be added with the 25 mL buffer solution to make thefinal microbubble solution in a total volume of 50 mL. The solution isdistributed to vials, and the headspace is filled with octafluoropropanegas through a septum cap. The vials is sealed and stored at a cooltemperature. The microbubbles are generated when desired by shakingusing a Vialmix shaker or an equivalent shaker.

In an alternative synthesis, targeting microbubble materials areprepared according to the following scheme:

Example 2: Synthesis of Targeting Microbubbles

A solution of microbubbles (untagged) was synthesized according to thefollowing procedure.

Material Source Information: For MPEG 5000 DPPE, the sodium salt wasused rather than the ammonium salt. Source: Genzyme Pharmaceuticals.DPPA: 1,2-dipalmitoyl-sn-glycero-3-phosphate, monosodium salt. Source:Avanti Polar Lipids. DPPC: 1,2-dipalmitoyl-rac-glycero-3-phosphocholinehydrate, approx. 99%. Source: Sigma.

Combined Phospholipids 2.times. Stock Solution (in water): Preparedaccording to the following table.

Mg in 50 mL Lipids Conc. In Definity of 2X stock soln. DPPA  0.45 mg/mL 4.5 mg DPPC 0.401 mg/mL 40.1 mg MPEG5000 DPPE 0.304 mg/mL 30.4 mg

The lipids were dissolved in water by heating to between 60-80° C. Thelipid solution was stored at 3° C. after preparation.

Buffer Solution: Prepared according to the following table.

Material Conc. in Definity Conc. in 2X stock Propylene glycol 103.5mg/mL  207.0 mg/mL  Glycerin 26.2 mg/mL 252.4 mg/mL  NaPhosphatemonobasic × 1H2O 2.34 mg/mL 4.68 mg/mL NaPhosphate dibasic, 10-hydrate2.16 mg/mL 4.32 mg/mL NaCl 4.87 mg/mL 9.74 mg/mL Water to 50 mL

The buffer solution was prepared at room temperature. 400 μL of lipidmix stock solution and 400 μL of buffer solution were transferred toamber vials, which were then sealed with silicone injection septum andscrew cap. The vial headspace was flushed with octafluoropropane. Asneeded, the vial is shaken 30 seconds in VialMix shaker at reducedtemperature.

Additional details for preparing Definity microbubbles (untagged) arefound in the procedure reported in Unger et al., Adv. Drug DeliveryRev., 56 (2004) 1291-1314, and references cited therein.

Example 3: Synthesis of Targeting Microbubbles Via Cross-Metathesis

Olefin metathesis is extensively used to rearrange carbon-carbon doublebonds in various organic syntheses. Especially, the second generationGrubbs catalysts, which are ruthenium atom centered and containsaturated mesityl-substituted N-heterocyclic carbene ligand, is suitableto prepare proposed microbubble chemical structures due to highcatalytic efficiency together with high tolerance of diverse functionalgroups, organic solvents in the air. The chemical tag, bisphosphonate,can be introduced to the phospholipid, bubble-forming material, by twosynthetic routes.

In the first method, the carbon double bond containing phospholipid, 5,and bisphosphonate containing structure, 2, are synthesized separatelyto produce product 2 and 5. Cross-metathesis can be performed betweenproduct 5 and product 2 in the presence of 2nd generation Grubbscatalyst. The cross-metathesis can prevent possible homodimerization ofproduct 2 due to poor electron density of carbon double bond of 2.Therefore, this selective cross-metathesis will help to avoid additionalpurification step to separate desired product 6 and undesired byproduct,homodimerized products.

An alternative synthetic method to produce bisphosphonate containingphospholipid is shown in the following scheme. Unlike previous syntheticroute, cross-metathesis reaction was carried out prior to introductionof bisphosphonate to phospholipids. Highly efficient reaction betweenNHS and primary amine can produce compound 8 without other undesiredproducts.

Example 4: In Vivo Administration of Microbubbles and Urinary StoneFragmentation

Rats (n=2) were anesthetized and a small intramuscular pocket wasdeveloped to instill 1.5-2.0 ml of microbubbles followed by placement ofa single urinary stone composed of calcium phosphate and calcium oxalate(1.5 grams). This was repeated in a remote location with the same animalwith a new stone fragment of the same composition. The intramuscularpockets were closed with 3.0 dexon sutures and the skin was closed withsubcuticular sutures. A 7.5 mHz ultrasonic transducer was then appliedto the skin with coupling gel. The stone and microbubbles were easilyidentified. Ultrasonic energy was applied for 15-20 minutes with directvisualization of both the stone and associated microbubbles. The stonewas retrieved and post-procedure stone weight decreased by approximately0.2 gram (dry then wet weight). Gross visualization revealed significantpitting on the stone surface demonstrating proof of concept of urinarystone fragmentation with microbubbles activated by ultrasonic energy. Animage of the stone is provided in FIG. 1.

Example 5: Attachment of Pendant Linker Groups to Attach Microbubbles toCalcium-Containing Materials

A series of experiments were conducted using chemistry in which theanchoring moiety and the targeting moiety are linked via an ionic chargebond, demonstrating that microbubbles comprising, e.g., phosphonatecoating structures can be appended to, e.g., calcium-containingmaterials (in this case, kidney stones) which have been modified topresent a cationic surface (in this case, acid or quarternary ammoniumsalts) using the methods described herein. This principle is illustratedin FIG. 2.

In one set of experiments, a kidney stone (calculous) was treated with0.1 M HCl, as shown pictorially in FIG. 3A, thus generating a positivecharge on the surface of the stone (calculous). When placed in thepresence of microbubbles containing a negatively charged phospholipidcoating (DEFINITY™ microbubbles), the microbubbles were shown to adhereto the positively charged stones (see, e.g., FIG. 4A). Upon applicationof ultrasonic energy, the microbubbles exhibited cavitation (FIG. 4B),after which the stones where shown to exhibit fracture damage (FIG. 4C).

A similar strategy may use targeting groups linked to cationic residues,thereby providing positively charged pendants attached to themetal-containing, especially calcium-containing materials which areattachable to microbubbles via ionic bonding to negatively chargedmicrobubbles (e.g., pictorially shown in FIG. 3B).

One such synthetic scheme available, using the methods described herein,involves the preparation of a quaternary ammonium compound based on, forexample, alendronic acid:

The bisphosphonate moiety (in this case, bisphophonic acid) has beenshown to exhibit a sufficiently strong attraction to kidney stones towithstand cavitation and fracture of the stone.

Additional materials are available from related starting materials,using chemistries recognized by the skilled artisan:

Calcium-containing materials may be treated by such quaternary ammoniumcompounds either before microbubble injection or simultaneously withmicrobubble injection.

Example 6: Synthesis of Microbubbles Using Small Molecule CancerousTumor Cell Specific Ligands

Microbubbles can also be prepared so as to target tumors using smallmolecule targeting moieties, including small molecule cancerous tumorcell specific ligands. Such microbubbles can optionally comprisetherapeutic pharmaceutical agents, or can be used simply to directultrasonic energy to damage or break-up the calculous or tumor body.There are many examples of small molecule cell specific agents, thoughnone of these appear to have been used as described in the presentcontext. In this non-limiting example, folate—which is known to be avery selective receptor to cancerous tumor and it is not harmful tohealthy cells.—is shown to be incorporated into a phospholipid moiety asthe target of the microbubble structure. An exemplary synthetic schemeis shown below.

It should be appreciated that other small molecule targeting moietiesmay be similarly attached, by methods known by the skilled artisan,using the teachings described herein, and these are considered withinthe scope of the present invention.

It is to be understood that while the invention has been described inconjunction with the preferred specific embodiments thereof, that theforegoing description and the examples that follow are intended toillustrate and not limit the scope of the invention. It will beunderstood by those skilled in the art that various changes may be madeand equivalents may be substituted without departing from the scope ofthe invention, and further that other aspects, advantages andmodifications will be apparent to those skilled in the art to which theinvention pertains. In addition to the embodiments described herein, thepresent invention contemplates and claims those inventions resultingfrom the combination of features of the invention cited herein and thoseof the cited prior art references which complement the features of thepresent invention. Similarly, it will be appreciated that any describedmaterial, feature, or article may be used in combination with any othermaterial, feature, or article, and such combinations are consideredwithin the scope of this invention.

The disclosures of each patent, patent application, and publicationcited or described in this document are hereby incorporated herein byreference, each in its entirety, for all purposes.

What is claimed is:
 1. A targeting microbubble comprising a compound offormula (I) or formula (II):


2. The targeting microbubble of claim 1 wherein the PEG has a molecularweight of less than 10,000 Daltons.
 3. The targeting microbubble ofclaim 1 wherein the PEG has a molecular weight of less than 5,000Daltons.
 4. The targeting microbubble of claim 1 wherein the PEG has amolecular weight of less than 1,000 Daltons.
 5. The targetingmicrobubble of claim 1, wherein the PEG is a polymer of 1-30 repeatunits, wherein each of the repeat units is an ethylene glycol monomer.6. The targeting microbubble of claim 1, comprising a compound selectedfrom the group consisting of:


7. The targeting microbubble of claim 1, further comprising a corecontaining a fluid having a normal boiling point less than 30° C.
 8. Thetargeting microbubble of claim 7, wherein the fluid is air, CO₂, afluorinated or perfluorinated C₁₋₆ hydrocarbon, or a combinationthereof.
 9. The targeting microbubble of claim 8, wherein the fluid isoctafluoropropane or dodecafluoropentane.
 10. A pharmaceuticalcomposition comprising a plurality of the targeting microbubbles ofclaim
 1. 11. The pharmaceutical composition of claim 10, furthercomprising a physiological fluid.
 12. The pharmaceutical composition ofclaim 10, further comprising water.
 13. The pharmaceutical compositionof claim 10, contained in a vial.
 14. The pharmaceutical composition ofclaim 13, wherein the vial further contains a fluid having a normalboiling point less than 30° C.
 15. The pharmaceutical composition ofclaim 14, wherein the fluid is air, CO₂, a fluorinated or perfluorinatedC1-6 hydrocarbon, or a combination thereof.
 16. The pharmaceuticalcomposition of claim 15, wherein the fluid is a fluorinated hydrocarbonselected from perfluoropropane and perfluoropentane.
 17. Thepharmaceutical composition of claim 10, wherein the plurality oftargeting microbubbles has an average diameter in the range of 1 micronto 10 microns.